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ACR I-Card Issuance Application Form
BI application form for the issuance of alien certificate of registration identity card
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: BI FORM 2014-08-006 Rev 0
This document cannot be reproducedand is NOT FOR SALE
APPLICATION FORM FOR ALIEN CERTIFICATE OF
REGISTRATION IDENTITY CARD (ACR I-CARD)
CONTROL NO:
I. GENERAL DETAILS
ACR Number
APPLICATION NO:
DEROGATORY RECORD
Official Receipt Number
Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
NO DERO
W/ DERO
Checked by: _____________________________
Certificate of Residence Number (CRN)
Date
: _____________________________
IDENTITY VERIFIED
Place of Issuance
_______________________________________
Fingerprint Examiner
Date
II. APPLICANT’S INFORMATION
Name Prefix (e.g. ATTY, FR, SR)
RECOMMENDING
APPROVAL
DENIAL
Remarks: _______________________________
Last Name
_______________________________________
_______________________________________
Registration Officer
Date
First/Given Name
REVIEWED BY:
Middle Name
_______________________________________
Reviewing Officer
Date
APPROVED BY:
Name Suffix (e.g. JR, SR, I-III)
_______________________________________
COMM/ARD CHIEF
Date
Other Name(s)/Alias(es)
1
2
Visa/Travel Information
Visa Number
Travel Document Details
Passport Number
Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
Name of Consulate
Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 1990]
Admission Status of Latest Arrival
Place of Issuance
Length of Stay
Contact Number(s) in the Philippines
Landline
Present Status
Mobile
Email Address
Other Information
Previous ACR Number
Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village
Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
Barangay, City/Municipality
Place of Issuance
Province, Zip Code
Citizenship/Nationality
Previous Subject of
Personal Description
Race
Blood Type
Personal Information
Gender
Male
Height [cm]
Eye Color
Weight [Kg]
Hair Color
Built
Complexion
Female
Civil Status
Single
Annulled
Separated
Distinguishing Marks
Married
Widowed
Divorced
Place of Birth
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]
Occupation
APPLICANT’S ACR I-CARD CLAIM STUB
Applicant’s Name [Last Name, First/Given Name, Middle Name (Please leave a box after each name)]
ACR Number
Visa Type
[IF THE ACR I-CARD IS CLAIMED BY AN AUTHORIZED REPRESENTATIVE, PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS.]
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BI FORM 2014-08-006 Rev 0
This document cannotbereproducedand is NOT FOR SALE
APPLICATION FORM FOR ALIEN CERTIFICATE OF
REGISTRATION IDENTITY-CARD (ACR I-CARD)
Name of Spouse [Last Name, First/Given Name, Middle Name]
Spouse’s Nationality
ARE YOU PLANNING TO LEAVE THE COUNTRY WITHIN THIRTY (30) DAYS UPON ISSUANCE OF ACR I-CARD?
YES
RP/SRC Number
RP/SRC Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
RP/SRC Type
NO
Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 19900]
Father’s Name [Last Name, First/Given Name, Middle Name]
AFFIDAVIT FOR PERSONS 14 YEARS OF AGE OR OVER
I have read the above statements or have had them read to me, and do hereby swear (or affirm) that these statements are
true and complete to the best of my knowledge and belief; furthermore, that I have not filed any application for this purpose still
pending or not given due course in another Immigration office.
___________________________
_____________________________________
(Signature of Applicant)
(Signature of Witness in case
Applicant does not know how to
write)
TIN : ________________________________
SUBSCRIBED AND SWORN TO before me this _______ day of __________________________ 20 at
_____________________________________;
Affiant/Applicant
exhibiting
to
me
his/her
Passport/CTC
No.
_________________________ issued on _________________________ at __________________________________________.
_____________________________________
(Registration Officer)
_____________________________________
(Official Designation)
AFFIDAVIT FOR PARENT OR GUARDIAN ONLY
I am the parent of/guardian of/person responsible for the above-named alien who is under 14 years of age/insane and have
made the above allegations for him/her. I have read or have had the same read to me, and do hereby swear (or affirm) that they
are true and complete to the best of my knowledge, information or belief; furthermore, that I have not filed any application for this
purpose in behalf of the above-named alien still pending or not given due course in another Immigration office.
________________________________
(Signature of Witness)
_____________________________________
(Signature of Parent, etc.)
TIN : ________________________________
SUBSCRIBED AND SWORN TO before me this _______ day of __________________________ 20 at
_____________________________________;
Affiant/Applicant
exhibiting
to
me
his/her
passport/CTC
No.
_________________________ issued on _________________________ at __________________________________________.
_____________________________________
(Registration Officer)
_____________________________________
(Official Designation)
DOCUMENTS PRESENTED: (*) Document to be retained and incorporated in the records.
1. *Old ACR No.
____________________________________ issued on ____________________ at _______________________________________________
2. ICR No.
____________________________________ issued on ____________________ at _______________________________________________
3. CLR No.
____________________________________ issued on ____________________ at _______________________________________________
4. Passport/CI No.
____________________________________ issued on ____________________ at _______________________________________________
5. CTC No.
____________________________________ issued on ____________________ at _______________________________________________
ACR I-CARD WILL ONLY BE RELEASED UPON COMPLIANCE/SUBMISSION OF THE FF:
Name of Representative _________________________________
Accredited Travel Agency/Law Office _______________________
BI Accreditation No. _____________________________________
Contact No. ___________________________________________
Residential /Office Address _______________________________
Signature_____________________________________________
1. Photocopy of passport bio-page of the ACR I-Card holder
2. Valid ID of either parent claiming the ACR I-Card, if applicant is a minor
3.Photocopy of the BI-Accreditation ID card, if claimed by a travel agent or law firm
4.Special Power of Attorney (SPA), if claimed by an authorized representative other than the
parent or BI accredited entity
ACR I-Card Holder: _________________________
Signature over PRINTED NAME
Claimant:_____________________
Signature
[Please call (+632) 525-7557 to check the status of your application]
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